Thursday, June 19, 2008

Hypothetical Situation

Summary: A patient was sent by her doctor for two "procedures" (for lack of better word) that turned out to be completely unnecessary. The reason the patient was sent was due to a lack of research or a simple verification of information on the part of the doctor (a.k.a. failing to ask the patient one question or to give the patient a thorough explanation of the procedures). In the end, there was no physical damage because of these two mistakes (as far as modern medical science is able to prove at this point), but financially it cost the patient about $500 from her own pocket. Naturally, the patient is frustrated with the incompetence of the doctor (and for other reasons as well), and wonders if there is any type of compensation available. Is there anything at all that can be done other than give poor recommendations for this doctor and never return?

Specifics: Procedure 1 was a total of $1,129 with the Insurance Contract Adjustment leaving the charges at $790.30. Insurance paid $715.42 while the patient paid $74.88. One of the charges on this bill was for a consultation that consisted of the doctor asking why the patient was there because it was totally unnecessary. Apparently that's worth $345. Thank goodness the Insurance decided to cover most of that one!

Procedure 2 was a total of $1,161.85 with the Insurance Adjustment leaving the charges at $606.47. Insurance paid $139.84 leaving the patient with $415.54. Why wasn't more covered? The patient intends to look more into the Insurance side of this bill. The patient has called the number on the bill to understand the charges. The associate had no idea why one was listed as a delivery room charge (almost $200) and the other pharmacy ($960), but both charges on the bill were apparently for the shot (which, may the reader be reminded, was completely unnecessary in the first place).

The Doctor has already been confronted, but mostly as a verification that the two procedures were unnecessary (which was confirmed without an apology) and following only the $75 bill (the other had not been received at the time). "We usually don't even ask because most people don't know" was the Doctor's response. In other words, "What do I care if someone actually does know the answer? No skin off my back, I don't lose out on $400."

Other Questions: Is $1,160 the normal cost of a shot these days? Is there any way for the patient to find out if those charges are correct (since the associate on the phone only knows what is on the bill, not if the charges are right)?Is there any way out of the $500?

Plea:If there is anyone reading this who is or knows someone with knowledge of these matters, please comment with advice for this poor patient. Five hundred dollars is not pocket change.

3 comments:

I have been very frustrated with similar (yet not so extreme) situations. My mother has asked why I actually pay the bill. She states that if we took our car to the body shop and they did nothing for us we would not pay them. In fact if there is any service that we are not satisfied with we do not pay.. . and in the case of products if we don't like it we call and say, we don't like it and they say, ok. Why are doctors so different!?! I know nothing. However, I think my mother is right. I would call and say, you know, i didn't recieve any service and I should not be charged. See what they say! the worst they can do is say, yes. then I say call gepheart! or what ever his name is, it is a shame you live in texas. . . but I bet there is someone like that in texas. that will probalby get you the best results because no one wants to be on the news for something like that, they would lose their practice.

Here is the blog post I was telling you about. I thought you'd enjoy it. Sorry about the bills!

A couple days ago we got our stimulus check from the government, and it is all gone in medical bills. It's all my fault, because I was having some unusual and painful health problems, so we decided to go ahead and do whatever tests the doctor ordered. Now we have the bills, and we'll never do that again. Why do I have to pay 60 dollars because they ran a test to figure out my blood type!!! I already know that!!! Why do some tests cost relatively little and others are crazy expensive. We will never go do lab work again w/o asking how much these tests cost to our insurance company, and never let a doctor order tests w/o seeing the lab sheet she fills out. I am so mad. She wanted to send me a third time for one of the 250.00 tests, and I finally said,"Is this really necessary? I have to pay 250.00 every time you send me for this." She said maybe not, and that I could wait on it and see if the problem resolved itself. I wish I had spoken up sooner. I think she is so used to medicaid patients that she doesn't get asked often about costs, or maybe she figures some people can afford it.

When I was in New York, Jeremy and Kim were telling me about how then ended up having a c-section because of difficulty with the baby's heart rate and they found out later the cord was wrapped around Elle's neck. As they were discussing the possibility of a c-section, Jeremy asked the doctor how much that would cost. He got a withering look, which made him laugh, like, why? Is it horrible to want to know the damage, and months/years it will take you to pay off such a proceedure? Yes, of course he would do anything for Kim and Elle's safety, but is it so awful to just ask? Apparently it was. Well, in my case it would have been a lot more helpful to ask 'How much?' before I let the doctor go wild. And as with EVERY visit I make to the doctor, nothing helpful came of it, my problems are resolving on their own, and I always wish I had just stayed home and kept my money in my pocket. I've got to raise one of my boys to be a doctor!!!

I would still make sure the coding was right on the bill and contest it. I wouldn't do much to the doctor confrontationally until after the baby is born since she will be attending the birth. Afterwards, I think a letter to her and the medical association would be warranted. We had to pay a large doctor bill becasue the receptionist took my insurance card, but didn't notice that it wasn't one they accepted. When notified, the doctor reduced the bill. When I went in for my foot surgery, we were told that we were responsible for the anesthesiologist. Dad called the insurance company right there in the waiting room to make sure he was on our plan. It's hard to ask questions or appear confrontational, but it is the only way to be informaed.